Management of plantar fibromatosis

evew · Dec 19, 2011

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Hi All,

I am looking for some advice for a patient that presented to me for assessment a few weeks ago.
He is a 39 year old male who is very active - predominantly running and triathalons.
Was running and noticed a sharp pain in the sole of his right foot 'felt like i had been shot'.
He visited a physio who treated him for plantar fasciitis - stretching, massage, post night splints etc to no avail.
He was worried that he had ruptured his plantar fascia - i referred him for an ultrasound which showed he has a 32x6x9mm (AP x SI x ML) plantar fibromatosis commencing 10mm distal to the calcaneal region. The radiologist recommended cortisone injection which he had last week.
I am seeing him again this week - he is keen to proceed with orthotics (as rec by his physio) however I am concerned that they may further irritate the area. Biomechanically he functions quite well - lunge test, sup resistance test, jacks test, STJ axis all within normal limits.
I would greatly welcome any feedback!
Kind Regards
Eve:santa2:

Admin2 · Dec 19, 2011

Related threads
Other threads tagged with lumps and bumps
Plantar fibromatosis

efuller · Dec 20, 2011

evew said: ↑

Hi All,

I am looking for some advice for a patient that presented to me for assessment a few weeks ago.
He is a 39 year old male who is very active - predominantly running and triathalons.
Was running and noticed a sharp pain in the sole of his right foot 'felt like i had been shot'.
He visited a physio who treated him for plantar fasciitis - stretching, massage, post night splints etc to no avail.
He was worried that he had ruptured his plantar fascia - i referred him for an ultrasound which showed he has a 32x6x9mm (AP x SI x ML) plantar fibromatosis commencing 10mm distal to the calcaneal region. The radiologist recommended cortisone injection which he had last week.
I am seeing him again this week - he is keen to proceed with orthotics (as rec by his physio) however I am concerned that they may further irritate the area. Biomechanically he functions quite well - lunge test, sup resistance test, jacks test, STJ axis all within normal limits.
I would greatly welcome any feedback!
Kind Regards
Eve:santa2:
Click to expand...

Is it visible or palpable?

JAYNES · Dec 21, 2011

Hi Eve i use orthotics for this problem all the time they do give relief.

Hope this helps
Jayne

evew · Dec 22, 2011

Hi Efuller,

No it is not visible or palpable. I did try some padding and strapping which did not alleviate any of his symptoms but rather irritated the area...

eve

evew · Dec 22, 2011

Hi Jaynes

thanks for replying.

any preference for orthotic material, modifications?

eve

efuller · Dec 22, 2011

evew said: ↑

Hi Efuller,

No it is not visible or palpable. I did try some padding and strapping which did not alleviate any of his symptoms but rather irritated the area...

eve
Click to expand...

Then an orthotic designed to reduce tension in the plantar fascia should work just fine. When the patient is in the chair, dorsiflex the hallux and if the plantar fascia is prominent a plantar fascial groove should be put into the orthosis.

Eric

evew · Dec 22, 2011

Thank you and Merry Christmas

Eve

NewsBot · Sep 24, 2013

High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose's disease).
Knobloch K, Vogt PM.
BMC Res Notes. 2012 Oct 2;5:542.

BACKGROUND:
Plantar fibromatosis is a benign disease creating nodules on the medial plantar side of affected patients. While surgical removal is regarded as the therapeutic mainstay, recurrence rates and impairment of daily activities remains substantial. High-energy focussed extracorporeal shockwave therapy has been suggested to be potentially effective in plantar fibromatosis in terms of pain reduction.
HYPOTHESIS:
High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis.
FINDINGS:
A total number of six patients (5 males, 58±4 years) were included with plantar fibromatosis (Ledderhose's disease) associated with pain. Three patients were operated on previously, one had concomitant Dupuytren's contracture. High-energy focussed ESWT was applied using a Storz Duolith SD1 (2000 impulses, 3 Hz, 1.24 mJ/mm²) in two sessions with 7 days between. Pain was 6±2 at baseline, 2±1 after 14 days and 1±1 after 3 months. Softening of the nodules was noted by all patients. No adverse effects were noted.
CONCLUSIONS:
High-energy focussed extracorporeal shockwave energy reduces pain in painful plantar fibromatosis (Morbus Ledderhose). Further large-scale prospective trials are warranted to elucidate the value of high-energy focussed extracorporeal shockwave therapy (ESWT) in plantar fibromatosis in terms of recurrence and efficacy.
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NewsBot · Oct 2, 2015

Patient-reported outcomes after electron radiation treatment for early-stage palmar and plantar fibromatosis.
Schuster J et al
Pract Radiat Oncol. 2015 Jul 2. pii: S1879-8500(15)00227-1

PURPOSE:
Palmar and plantar fibromatosis (PPF) is a progressive connective tissue disorder of the hand/foot that often leads to debilitating functional impairment. In Europe, orthovoltage radiation therapy (RT) has been demonstrated to prevent local disease progression for up to 80% of patients with early-stage PPF. There are limited data reporting outcomes for populations outside of Europe or using electron RT.
METHODS AND MATERIALS:
Between 2008 and 2013, 44 early-stage PPF cases received RT. RT fields involved clinically defined targets encompassing involved areas (skin changes, cords, nodules) with at least 1.5-cm margins. En face electrons (6-12 MeV) and bolus (0.5-1 cm) were selected individually. Outcomes are reported for patients who participated in an institutional review board-approved standardized questionnaire and chart review.
RESULTS:
Thirty-three patients received 66 treatments (45 hands/15 feet and 6 reirradiations). Most frequent dose schemes were 21 Gy (3 Gy in 7 fractions) and 30 Gy (3 Gy in 10 fractions with 6- to 8-week breaks after 15 Gy). Median time to follow-up survey was 31 months. Disease progression at any location within or outside the RT treatment field occurred in 20 of 33 patients (61%). Fourteen of 60 sites (23%) developed in-field progression, but 4 sites were successfully reirradiated with final local control in 50 of 60 sites (83%). RT improved pretreatment symptoms of pain with strain at 30 of 37 sites (81%) and itch/burn sensations at 17 of 21 sites (81%). There were no reported grade ≥2 late toxicities even with reirradiation. Patient reported overall success with treatment was 31 of 33 patients (94%).
CONCLUSION:
PPF is a progressive disease. En face electron RT is an effective therapy that stabilizes or improves symptoms in the majority of patients. Reirradiation can be considered as a treatment option for in-field progression. Patients report minimal toxicity and a high rate of satisfaction with treatment.
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Louelle · Nov 26, 2015

I've had excellent results using ESWT for plantar fibromatoma (albeit very small sample but still - very promising)

NewsBot · Sep 27, 2016

Dupuytren-Like Contracture of the Foot: Ledderhose Disease
Osman Akdag et al
Surg J 2016; 02(03): e102-e104

Introduction Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report.

Case Report A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance.

Discussion Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery.

Conclusion The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.
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NewsBot · Dec 23, 2017

Plantar fibromatosis: Surgical approach of a giant bilateral case
Jorge Ocampo-Garza et al
International Journal of Dermatology 19 December 2017

Background
Plantar fibromatosis or Ledderhose disease is characterized by a benign fibroblastic proliferation of the plantar fascia. It is an illness with unknown etiology and a complex treatment in its most intense manifestation.

Objective
The authors describe a surgical option for extensive cases where conservative treatments are not successful. Surgical techniques may vary according to the site and extent of the lesions.

Methods
Surgical treatment with wide resection of the lesion and second intention healing using a hydrocolloid dressing.

Results
After a 3-year follow-up with no recurrence, the authors demonstrated an excellent result, which led to an important improvement in the patient's quality of life.

Conclusion
Surgical treatment can be a good option for plantar fibromatosis. Giant lesions can be treated with wide excisions and second intention healing, with low risk of aesthetic and functional complications.
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NewsBot · Apr 6, 2018

Ultrasonography of Plantar Fibromatosis: Updated Case Series, Review of the Literature, and a Novel Descriptive Appearance Termed the "Comb Sign".
Cohen BE et l
Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine [30 Mar 2018]

The purpose of this series is to review the appearance of plantar fibromatosis with high-resolution ultrasonography (US) and highlight a new imaging sign termed the "comb sign." A retrospective study was performed for patients with a clinical diagnosis of plantar fibromatosis. Charts of 43 patients (age range, 26-77 years; mean age, 54 years) were reviewed to gather patient demographics and symptoms. Several US characteristics were evaluated with emphasis on any new imaging features. A total of 57 plantar fibromas in 43 patients were examined. Plantar fibromatosis was seen as a lobular marginated oval nodule along the superficial plantar fascia involving the central or medial cord, often at the middle third (84%) of the plantar fascia, showing posterior acoustic enhancement (65%), mixed echogenicity (82%), and intralesional vascularity (53%). Slightly more than half (51%) of the lesions showed a previously unrecognized appearance, designated the comb sign. This sign was more commonly seen in the setting of larger fibromas (P < .05). Plantar fibromatosis is usually a clinical diagnosis that can be aided by a typical US appearance. Although the imaging characteristics are largely similar to prior literature, this series suggests that most show mixed echogenicity and posterior acoustic enhancement, and approximately half show internal vascularity. A new US sign, termed the comb sign, shows alternating bands of hypoechogenicity and isoechogenicity, particularly in larger plantar fibromas, and can help in further characterization.
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NewsBot · Jun 12, 2018

Current concepts about treatment options of plantar fibromatosis: A systematic review of the literature
Mario Fuiano et al
Foot and Ankle Surgery; 11 June 2018

Highlights
•Plantar fibromatosis (or Ledderhose’s desease) is a benign condition, but characterized by local aggressiveness and high recurrence rate.
•Plantar fibromatosis often tends to recur after operative removal. A complete excision of the lesion without leaving pathological tissue is necessary to minimize the risk of recurrence.
•Conservative treatment should always be the first approach.
•Local or marginal excision are not recommended in the treatment of this disease, both in primary than in recurrence cases. An exception could be lesions still very small and locally not aggressive, in patients with a low risk of recurrence.
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Background
Plantar fibromatosis, or Ledderhose disease, is a benign and hyperproliferative disease of the plantar aponeurosis.There have been described different therapeutic options regarding plantar fibromatosis, both conservative and surgical. The aim of this review is to systematically analyze conservative and operative treatments of plantar fibromatosis described in literature, evaluating which procedure shows the highest success rate and best functional outcome.

Methods
A systematic review of PubMed, Google Scholar and Cochrane reviews computerized database was performed focusing on the different types of treatments for plantar fibromatosis. Research was performed using the keywords “plantar”, "fibromatosis”, “Ledderhose”, “Dupuytren”, “foot” in order to identify all papers regarding the treatment of plantar fibromatosis. In addition, the research was extended to the reference list of the relevant articles. A total of 25 citations were obtained from the research and included.

Results
Considering all the studies, 233 patients were included in this systematic review. 5 studies reported conservative treatment of plantar fibromatosis, with a total of 35 patients included. Operative outcomes are reported for 178 patients (92 male, 86 female), with 196 feet treated.

Conclusions
Valid conservative methods are presented in literature, with debated results. Some operative options show high recurrence rate; wide excision is recommended in selected cases. Further clinical trials with well-defined and standardized outcome measurements should be necessary in future to better evaluate success rate and complications of the various procedures.
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NewsBot · Mar 28, 2019

Ledderhose’s Disease-What do We Know
and What do We not know
Ingo Schmidt et al
SM Musculoskelet Disord. 2019; 4(1): 1033.

Plantar fibromatosis of the foot (i.e. Ledderhose’s disease) is a rare benign but local aggressive disease
of the plantar aponeurosis (i.e. fascia) with unknown etiology. Histopathological findings in plantar fibromatosis
reveal similar findings to those in palmar fibromatosis (i.e. Dupuytren’s disease), and genetic factors (i.e. familial
history) for its appearance seems to be of relevance. Treatment options include various non-surgical and surgical
procedures; however, progression of disease after non-surgical treatment and recurrence after surgery is a
concern. But in trend, total plantar fasciectomy seems to be superior compared to all other procedures. The
aim of this short review article is to give practicable interdisciplinary insights on a surgeon’s perspective for all
clinicians who are confronted with this rare disease including various differential diagnoses related to chronic
plantar foot pain, and possible complications after its treatment.
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NewsBot · Mar 30, 2019

Palmar Fibromatosis: an Analysis of 25 Cases
Source

Objective: Dupuytren’s contracture (DC) is a benign tumor that results in nodular or fibrous band-like thickening of the palmar fascia and leads
to palmar and digital contractures. Although they are benign lesions, post-operative recurrence is frequent. In the present study, we retrospectively
analyzed clinicopathological findings of 25 cases that underwent surgery for DC. We also aimed to determine the relationship between relapse and
Ki-67 proliferation index and smooth muscle actin (SMA) staining intensity in excision materials by immunohistochemical method.
Methods: The demographic characteristics, severity of contracture, treatment type, Ki-67 proliferation index, SMA staining intensity and recurrence
were evaluated retrospectively in 25 patients who were operated with the diagnosis of DC at the Department of Orthopedics and Traumatology in
Recep Tayyip Erdogan University between 2009 and 2015.
Results: The age range of the patients was 42-75 years (mean age: 55 years), and 6 were female and 19 were male. Fifteen of the lesions were in the
right hand, and 10 were in the left hand. All patients underwent extensive palmar fascia excision with regional intravenous anesthesia. Only one
patient had recurrence. Ki-67 proliferation index was 1-2% in patients without recurrence, however, >5% nuclear positivity was detected in a patient
with recurrence. In addition, strong positive staining for SMA was observed in this patient.
Conclusion: The use of Ki-67 proliferation index and SMA staining intensity to evaluate fibroblastic proliferation in the pathological examination of
surgical DC specimens may be valuable in clinical follow-up in terms of recurrence
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NewsBot · Nov 6, 2019

The Effects of Collagenase Clostridium histolyticum on Plantar Fibromatosis: A Case Study
Jeffrey D.Lehrman et al
The Journal of Foot and Ankle Surgery
Volume 58, Issue 6, November 2019, Pages 1281-1284

Plantar fibromatosis, also known as Ledderhose's disease, is a rare disorder of benign fibroblast proliferation involving the plantar aponeurosis (i.e., plantar fascia). Traditionally, surgical intervention has been the most common treatment for plantar fibromatosis. However, numerous studies have reported high recurrence rates of plantar fibromatosis after surgical intervention, as well as wound healing difficulties and nerve injury. Plantar fibromatosis often coexists with other superficial fibrous diseases such as Dupuytren's contracture and Peyronie's disease; immunohistochemical and ultrastructural analyses suggest a relationship between Ledderhose's disease and Dupuytren's contracture. The US Food and Drug Administration approved collagenase Clostridium histolyticum for the treatment of Dupuytren's contracture in 2010 and Peyronie's disease in 2013. This case study presents the successful treatment of Ledderhose's disease almost 4 years (45.5 months) after off-label use of collagenase C. histolyticum injection in a 22-year-old white female who had recurrent plantar fibromatosis after surgical intervention.
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NewsBot · Oct 16, 2020

Follow-up of clinical and sonographic features after extracorporeal shock wave therapy in painful plantar fibromatosis
Jin Tae Hwang et al
PLoS One. 2020 Aug 10;15(8)

Background: Extracorporeal shock wave therapy (ESWT) has been used as a safe alternative treatment for refractory musculoskeletal diseases, such as plantar fasciitis, Achilles tendinopathy and gluteal tendinopathy, and various forms of fibromatosis including palmar or penile fibromatosis. However, there is limited published data for clinical and sonographic features of plantar fibromatosis after ESWT. The purpose of this study was to evaluate the long-term clinical outcome of ESWT in ultrasonography-confirmed plantar fibromatosis and ultrasonographic changes of plantar fibroma after ESWT.

Methods: Medical charts of 26 patients (30 feet) with plantar fibromatosis confirmed by ultrasonography were reviewed. Finally, a total of 10 feet who underwent ESWT for "Poor" or "Fair" grade of Roles-Maudsley Score (RMS) and symptoms persisted for >6 months were included in this study. Short-term follow-up was conducted one week after ESWT and long-term follow-up time averaged 34.0 months. The Numerical Rating Scale (NRS) and RMS were collected for the evaluation of clinical features. Follow-up ultrasonography was conducted at long-term follow-up and changes of plantar fibroma was assessed. A greater than 50% reduction in the NRS and achievement of a "good" or "excellent" grade in the RMS were regarded as treatment success. Additionally, medical charts of 144 patients (168 feet) with plantar fasciitis confirmed by ultrasonography were reviewed and subsequently, 42 feet who underwent ESWT with the same protocol were included for the comparison of clinical features.

Results: In plantar fibromatosis, baseline NRS (6.2 ± 1.3) and RMS (3.5 ± 0.5) were significantly improved at short-term follow-up (NRS, 1.8 ± 1.0; RMS, 2.0 ± 0.8, P < .001, respectively) and long-term follow-up (NRS, 0.6 ± 1.1; RMS, 1.4 ± 0.8, P < .001, respectively). Treatment success was recorded in seven feet (70.0%) at short-term follow-up and 8 feet (80%) at long-term follow-up, which is comparable to that of the plantar fasciitis group (28 feet, 66.7%; 35 feet, 83.3%, respectively). In long-term follow-up ultrasonography, mean fibroma thickness was reduced from 4.4±1.0 to 2.6±0.8 mm (P = .003); however, length and width were not significantly changed. There were no serious adverse effects.

Conclusion: While these are preliminary findings, and must be confirmed in a randomized placebo control study, ESWT can have a beneficial long-term effect on pain relief and functional outcomes in painful plantar fibromatosis. However, ESWT is unlikely to affect the ultrasonographic morphology of plantar fibroma, with the exception of reducing the thickness.
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docbourke · Aug 23, 2020

Plantar fibromatosis is a benign, self limiting condition. In the early stages it can be tender but after a few months it becomes pain free. Orthotics can be useful if there is a painful, tender lump to unload the spot itself. Once thhe pain and tenderness have gone the orthotics are not needed. If the fibroma is operated on or even innjeeted there is a significant risk that it will recur in a more aggressive form and in larger numbers so injection and surgery are contra indicated. Plantar fibromata are common incidental findings and if it is not palpable then it is most likely not the cause of the symptoms unless it is the early stages and it is still growing.

Ed Davis DPM · Oct 16, 2020

Plantar fibromatosis or Ledderhose Disease is occasionally self limiting but there are many cases that are disabling. Surgical treatment has an unacceptably high recurrence rate. I have been using, off label, hyaluronidase injections, with good results for a number of years. Unfortunately, the system here does not allow me to post links to additional information.

NewsBot · Aug 10, 2021

Recurrence Rate After Wide Resection of Plantar Fibromatosis: A Case Series and Systematic Literature Review
Helen Anwander et al
Foot Ankle Spec. 2021 Aug 8

Background: The aim was to assess the recurrence rate and clinical outcome after wide resection for plantar fibromatosis.

Methods: A total of 12 patients, 2 to 13 years after wide resection, were assessed for local and magnetic resonance imaging tomographic signs of recurrence at the clinical follow-up. In addition, a systematic review of the literature was conducted.

Results: After 7.8 years (2-13), 2 patients (17%) suffered a recurrence. At the last follow-up, median Foot Functional Index was 1 (0-66) and American Orthopaedic Foot and Ankle Society score was 95 (44-100). Six studies with 109 feet (92 patients) were included in the systematic review. The recurrence rate depends on the width of the resection: 67% after local resection, 42% after wide resection, and 27% after fasciectomy.

Conclusion: In patients with symptomatic plantar fibromatosis, we recommend a wide resection or fasciectomy over a local resection because of the inferior recurrence rate.
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NewsBot · Oct 19, 2021

Radiation Therapy in the Treatment of Plantar Fibromatosis – Two Clinical Cases of Recurrent Disease

NewsBot · Apr 6, 2023

A Case Report of
Bilateral Plantar Fibromatosis
and Review of Treatment Options
Dimitrios ZACHARIOU et al
MAEDICA – a Journal of Clinical Medicine

Ledderhose disease is a rare benign pathology defined by the formation of nodules along the plantar fascia.
The fibromas can slowly grow, resulting in pain and functional disability. Diagnosis is mainly clinical, but
it is advised to confirm with an MRI or ultrasound scan. Multiple options of conservative treatment have
been suggested with varying levels of evidence. Initially, the treatment aims to relieve symptoms and pain.
Treatment options such as extracorporeal shockwave therapy, radiotherapy, intralesional steroid injection,
Clostridium histolyticum collagenase injections, Verapamil and Tamoxifen can be used if the symptoms
persist. A partial or complete fasciectomy is often performed in cases where conservative treatment fails. We
present a case of bilateral plantar fibromatosis treated with extracorporeal shockwave therapy and transfer
electrical capacitive and resistive therapy. The patient had an intense pain during the shockwave therapy
sessions, which significantly decreased after the transfer electrical capacitive and resistive therapy protocol.
At the 12-month follow-up, the patient showed significant improvement in the Visual Analog Scale from
6/10 to 1/10 on the right foot and from 8/10 to 4/10 on the left foot.
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NewsBot · Jun 5, 2023

"Modifiable Risk Factors for Prevention in Dupuytren's Disease: A UK Biobank Case-Control Study."
Youngjoo Kang et al
Plast Reconstr Surg. 2023 May 31.

Background: Dupuytren's disease is associated with significant co-morbidity and mortality, and has no existing prevention strategies. It is unclear which modifiable risk factors are most amenable for prevention. This study aimed to determine the strength of modifiable risk factors for Dupuytren's disease, and to investigate associations with other diseases.

Methods: Using UK Biobank data, this case-control study analysed the association between phenotypic variables and Dupuytren's disease through multivariable logistic regression. Exposures assessed were Age, Sex, Body Mass Index, Waist-Hip Ratio, Townsend Deprivation Index, Smoking status, Alcohol intake, Diabetes Mellitus, Hypertension, Cancer, Liver disease, Respiratory disease, Rheumatoid arthritis, Epilepsy, Psoriasis, and Gout.

Results: There were 4,148 cases and 397,425 controls. Male sex (OR 3.23, 95%CI 2.90 - 3.60, P=1.07×10 -100), increasing age (OR 1.08, 95% CI 1.07 - 1.08, P=6.78×10 -167), material deprivation (OR 1.01, 95%CI 1.00 - 1.02, P=0.0305), HDL cholesterol (OR 1.76, 95%CI 1.58 - 1.96, P=3.35×10 -24), smoking exposure and alcohol intake were all associated with increased odds of Dupuytren's disease. With increasing obesity class, there was approximately 25% decreased odds (OR 0.774, 95% CI 0.734 - 0.816, P=4.71×10 -21). Diabetes with microvascular or end-organ complications was associated with more than 2.5 times increased odds of Dupuytren's disease (OR 2.59, 95%CI 1.92 - 3.44, P=1.92×10 -10). Within this group, increasing HbA1c values by 10 mmol/mol, or 0.9%, increased the odds by 31% (OR 1.31 95%CI 1.13 - 1.51, P=2.19×10 -4).

Conclusions: Diabetes and poor glycemic control are major risk factors for Dupuytren's disease, which present an opportunity for prevention.
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NewsBot · Oct 4, 2023

Flexion Contracture and Valgus Deformity of the Great Toe are Symptoms
of Plantar Fibromatosis
Hiroshi Kishimaru
Clin Res Foot Ankle 2023, 11:9

A soft tissue benign lesion that is relatively infrequent is plantar fibromatosis. The middle and medial regions of the
plantar fascia are where it is most frequently discovered to be involved, and it frequently co-occurs with other fibrous
proliferating illnesses. The literature on this typically unencapsulated fibrous growth is thoroughly reviewed by the
writers. Also described is a rare instance of a relatively big encapsulated tumour that underwent dorsal extension into
the plantar muscles.
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NewsBot · Oct 30, 2023

Ultrasound-Guided Collagenase Injection Therapy of Recurrent Plantar Fibromatosis: A Case Report
Antje L. Greenfield et al
Source

Plantar fibromatosis, also known as Ledderhose disease, is benign nodular hyperplasia of fibroblastic connective tissue of the plantar fascia.7
Patients experience slowly enlarging palpable nodules located in the soft tissues of the plantar foot. These masses can be asymptomatic, especially when they are small. In some patients, the fibromatous nodules become quite large and painful, resulting in difficulty walking or fitting shoes.4
These lesions are histologically similar to Dupuytren’s contracture and Peyronie’s disease and can coexist.9
Current treatments include conservative and surgical options if conservative therapies are unsuccessful. Nonoperative management includes physical therapy, orthotics, radiotherapy, nonsteroidal antiinflammatory drugs, and intralesional corticosteroid injection. Surgical resection is reserved for tumors that have failed conservative management. Such masses are generally large, painful, or refractory to orthotics; treatment ranges from local excision to plantar fasciectomy.10 Surgical complications include high recurrence rates, wound infections, delayed healing, and nerve damage.10
Injection therapy with collagenase has been approved by the US Food and Drug Administration (FDA) for Dupuytren’s contracture and Peyronie’s plaques for over 10 years. Collagenases are enzymes that hydrolyze collagen, thereby softening and shrinking masses primarily composed of collagen aggregates.
Although plantar fibromatosis is histologically identical to Dupuytren’s contracture and Peyronie’s disease, collagenase injection treatment for plantar fibromatosis to date has not been FDA-approved because of the lack of adequate clinical trials to demonstrate efficacy and safety. A few published case reports of off-label use of collagenase injection therapy support the effectiveness of this treatment.3,8
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NewsBot · May 23, 2024

Recurrence Rate After Wide Resection of Plantar Fibromatosis: A Case Series and Systematic Literature Review
Helen Anwander et al
Source

Background
The aim was to assess the recurrence rate and clinical outcome after wide resection for plantar fibromatosis.
Methods
A total of 12 patients, 2 to 13 years after wide resection, were assessed for local and magnetic resonance imaging tomographic signs of recurrence at the clinical follow-up. In addition, a systematic review of the literature was conducted.
Results
After 7.8 years (2-13), 2 patients (17%) suffered a recurrence. At the last follow-up, median Foot Functional Index was 1 (0-66) and American Orthopaedic Foot and Ankle Society score was 95 (44-100). Six studies with 109 feet (92 patients) were included in the systematic review. The recurrence rate depends on the width of the resection: 67% after local resection, 42% after wide resection, and 27% after fasciectomy.
Conclusion
In patients with symptomatic plantar fibromatosis, we recommend a wide resection or fasciectomy over a local resection because of the inferior recurrence rate.
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NewsBot · Aug 9, 2024

Press Release:
Endo Presents New Data at the American Podiatric Medical Association Annual Meeting

MALVERN, Pa., Aug. 8, 2024 /CNW/ -- Endo, Inc. ("Endo") (OTCQX: NDOI) announced today that new data related to collagenase clostridium histolyticum (CCH) and plantar fibromatosis will be presented during the American Podiatric Medical Association's (APMA) annual scientific meeting, The National, taking place August 8-11, 2024 in Washington, DC.

"We're pleased to share new data about plantar fibromatosis with healthcare providers who care for and treat patients with the condition, which can be painful and burdensome," said James P. Tursi, M.D., Executive Vice President, Global Research & Development at Endo. "Encouraged by the clinical study data being presented at APMA, we are advancing our Phase 3 clinical study to explore a potential nonsurgical option in the future."

The results of the Phase 2 plantar fibromatosis study demonstrated a trend in CCH treatment effect over placebo for reducing pain associated with the condition as measured by the Foot Function Index Total Pain subscale score, as well as nominally significant improvements of CCH versus placebo in the investigator assessment of improvement, nodular hardness (durometer), and nodule consistency (firmness by investigator palpation) scales. In addition, the CCH safety profile was consistent with the known CCH safety profile from other clinical studies and indications. Most adverse events were rated as mild to moderate, and there were no reported treatment-related serious adverse events.

The retrospective analysis of 2,273 patient charts demonstrated that patients with plantar fibromatosis appear to suffer from both direct and indirect symptom burdens. Almost two-thirds of patients in the overall cohort reported PFI-specific foot pain with nearly 90% of these describing the pain as moderate or severe. The analysis also reported on current treatment approaches for plantar fibromatosis.

The three new poster presentations are below:

Endo Presents New Data at the American Podiatric Medical Association Annual Meeting
A Phase 2, Double-blind, Randomized, Placebo-Controlled Study to Assess Collagenase Clostridium Histolyticum vs Placebo in Patients With Plantar Fibromatosis

Authors: Joseph Caporusso, DPM; Ira Gottlieb, DPM; Jason Levy, DPM, FACFAS; Saadiq El-Amin, MD; Sara E. Suttle, DPM, FACFAS; James Tursi, MD; Nigel Jones, PharmD; Luis Ortega, MD; Gongfu Zhou, PhD; C. James Anderson, DPM

Characterization of Patients With Plantar Fibromatosis: Examining Baseline Characteristics From a Phase 2 Study of Collagenase Clostridium Histolyticum

Authors: Joseph Caporusso, DPM; Ira Gottlieb, DPM; Jason Levy, DPM, FACFAS; Saadiq El-Amin, MD; Sara E. Suttle, DPM, FACFAS; James Tursi, MD; Nigel Jones, PharmD; Luis Ortega, MD; Gongfu Zhou, PhD; C. James Anderson, DPM

Clinical Characteristics of Plantar Fibromatosis Derived from Transcription Notes

Authors: Jill Davis, David Hurley, Jennifer Black-Shinn, Fernando Otalora, Esteban Masuelli, Eddie Davis

CCH is not approved for use in treating patients with plantar fibromatosis. Endo is currently enrolling patients in the pivotal Phase 3 program.

About Plantar Fibromatosis
Plantar fibromatosis (PFI) or Ledderhose disease is a hyperproliferative fibrous tissue disorder resulting in the formation of nodules along the plantar fascia, the thick connective tissue that supports the arch of the foot, which is often painful. There is no cure for PFI. Symptom management options include custom insoles, topical treatments, over-the-counter pain and anti-inflammatory medications, radiation therapy and steroid injections, and ultimately, surgery may be required to remove the nodules.

NewsBot · Aug 21, 2024

Ledderhose's Disease
Manare Jaai et al
Cureus. 2024 Jul 15;16(7):e64593

Ledderhose disease, also known as plantar fibromatosis, is a rare fibroproliferative disorder characterized by the development of fibrous nodules within the plantar fascia of the foot. These nodules cause discomfort, pain, and impaired mobility, particularly during activities like walking, and are often associated with other fibromatoses, such as Dupuytren's disease. In this case, a 60-year-old woman presented with significant plantar pain exacerbated by walking, along with swelling in the arch of her foot. The diagnosis involved a clinical examination that revealed nodules and tenderness in the plantar fascia, and ultrasound imaging confirmed the presence of fibrotic tissue. Due to the patient's preference for non-surgical management, a conservative approach was adopted. This included the use of medications, orthotic devices, and physical therapy. This case underscores the effectiveness of non-surgical interventions in managing Ledderhose disease, highlighting the importance of personalized treatment plans tailored to patient preferences.
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NewsBot · Oct 18, 2024

Imaging of Multinodular Plantar Fibromatosis—Ledderhose Disease Associated with Dupuytren’s Contracture
Nisarga B. V., Ashwin Kumar A., G. Murugan & J. Thanka
Indian Journal of Surgery Article: 13 October 2024

Ledderhose disease or plantar fibromatosis is a very rare benign hyperproliferative disorder of the plantar aponeurosis. It is often found in association with other fibromatoses such as Dupuytren’s disease and Keloids and Peyronie disease. Magnetic resonance imaging (MRI) confirmed the diagnosis of multiple fibromatosis associated with Dupuytren’s contracture. As this is a progressive fibroproliferative disease, early detection and diagnosis play an important role in conservative management. For patients with persistent pain or associated complications, surgical management is advised.
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NewsBot · Jul 25, 2025

Press Release:

Endo Presents Plantar Fibromatosis and Plantar Fasciitis Data at the American Podiatric Medical Association Annual Meeting
Jul 24, 2025, 07:30 ET

MALVERN, Pa., July 24, 2025 /PRNewswire/ -- Endo, Inc. (OTCQX: NDOI) announced today that three presentations related to plantar fibromatosis (PFI) and plantar fasciitis (PFA) will be shared during the American Podiatric Medical Association Annual Meeting, taking place July 24-27, 2025.

The first two presentations cover findings from Phase 1 and Phase 2 studies of collagenase clostridium histolyticum (CCH) in patients with PFA and PFI, respectively, while a third presentation features a retrospective analysis of insights from patients with PFI.

"We're pleased to share clinical trial data with healthcare providers as part of our ongoing efforts to help improve patient care and highlight our clinical development strategy," said James P. Tursi, M.D., Executive Vice President, Global Research & Development at Endo. "We are advancing a Phase 3 study aimed at exploring a potential nonsurgical treatment option for patients with PFI, further demonstrating our commitment to developing medicines that address challenging and burdensome conditions."

The three Endo-supported presentations are below:

Collagenase Clostridium Histolyticum (CCH) in Patients With Plantar Fibromatosis (PFI): Post hoc Analysis of a Phase 2, Double-blind, Randomized, Placebo-Controlled Study
Authors: C. James Anderson, DPM; Ira Gottlieb DPM; Jason Levy, DPM, FACFAS; Saadiq El-Amin, MD, PhD; Sara E. Suttle, DPM, FACFAS; James Tursi, MD; Nigel Jones, PharmD; Luis Ortega, MD; Gongfu Zhou, PhD; Joseph Caporusso, DPM

Understanding the Lived Experiences of People With Plantar Fibromatosis (PFI): A Mixed Methods Study
Authors: Joseph Caporusso, DPM; David Hurley, MD; Carrie Lewis, MS; Gary Manley, BSc; Laura Iliescu, MSc; and Luis Ortega, MD

A Phase 1, Single-Blind, Randomized, Placebo-Controlled Dose Escalation Study to Assess Collagenase Clostridium Histolyticum (CCH) vs Placebo in Patients With Plantar Fasciitis (PFA)
Authors: Joseph Caporusso, DPM; Ira Gottlieb, DPM; Jason Levy, DPM; Saadiq El-Amin, MD, PhD; Sara Suttle, DPM; James Tursi, MD; Nigel Jones, PharmD; Luis Ortega, MD; Jeffrey Andrews, MS; C. James Anderson, DPM

CCH is not approved for use in treating patients with PFI or PFA. Endo is currently enrolling patients in the pivotal Phase 3 program for PFI.

About the Phase 2 PFI Study
A post hoc analysis of Phase 2 data identified a subgroup of PFI patients who appeared to respond well to CCH treatment. After excluding certain patients, those treated with CCH showed improvements in pain, nodule hardness, and overall condition compared to placebo. The subgroup also demonstrated greater treatment benefits than the original study population. A Phase 3 trial is currently underway with this refined population.

About the PFI Retrospective Analysis
The retrospective analysis of 91 patients synthesizes three patient voice studies, revealing that individuals with PFI are experiencing varying degrees of pain—those reporting moderate to severe pain face greater physical, emotional, and daily life burdens. Participants expressed dissatisfaction with current treatments and a strong interest in nonsurgical options like collagenase clostridium histolyticum, highlighting a need for therapies that reduce or halt nodule growth.

About the Phase 1 PFA Study
A Phase 1 proof-of-concept study evaluated the safety, tolerability, and effectiveness of a single CCH dose for PFA. The safety profile aligned with known adverse events (AE) and were mostly rated mild to moderate. Higher CCH doses had more frequent and severe AEs. CCH treatment showed improvements across all effectiveness measures compared to placebo, though significance was not assessed. These results supported further investigation in a Phase 2 trial.

About Plantar Fibromatosis
PFI or Ledderhose disease is a hyperproliferative fibrous tissue disorder resulting in the formation of collagen nodules along the plantar fascia, the thick connective tissue that supports the arch of the foot, which is often painful. There is no cure for PFI. Symptom management options include custom insoles (orthotics), topical treatments, over-the-counter pain and anti-inflammatory medications, radiation therapy and steroid injections, and ultimately, surgery may be required to remove the nodules.

About Plantar Fasciitis
PFA causes foot discomfort due to inflammation and degeneration of the tissue connecting the heel to the toes, resulting in prominent heel pain. It is especially noticeable when starting to walk in the morning or after prolonged sitting or standing. There is no cure for PFA. Symptom management options include conservative options such as orthotics, icing, stretching, bracing, over the counter pain and anti-inflammatory medications with surgery reserved for more chronic presentations to relieve the tension in the plantar fascia.

About Endo
Endo is a diversified pharmaceutical company boldly transforming insights into life-enhancing therapies. Our passionate team members collaborate to develop and deliver these essential medicines.

NewsBot · Dec 18, 2025

The Surgical Treatment of Plantar Fibromatosis With Multiple Large Nodules on the Medial Aspect of the Left Sole With No Recurrence at the Five-Year Follow-Up
Christos Lyrtzis et al
Cureus. 2025 Dec 16;17(12):e99349.

Plantar fibromatosis, or Ledderhose disease, is a rare benign fibroproliferative disorder of the plantar fascia characterized by the development of fibrous nodules, which may cause pain and functional limitation. Although the exact etiology remains unclear, it has been associated with trauma, diabetes mellitus, liver disease, epilepsy, and chronic alcohol use. Management is often conservative, but surgical intervention may be required when symptoms persist. A 32-year-old female presented with a six-month history of painful nodules on the medial aspect of her left sole. Clinical examination and ultrasonography revealed three hypoechoic nodules within the plantar fascia. Initial conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), stretching, orthotic insoles, and physiotherapy failed to improve symptoms. Surgical excision with partial plantar fasciectomy was therefore performed. Histopathological examination confirmed the diagnosis of plantar fibromatosis, showing dense fibrocellular tissue with fibrocytic and collagenous proliferation and myofibroblastic differentiation. The postoperative recovery was uneventful, and at five-year follow-up, the patient remained pain-free with no evidence of recurrence. Plantar fibromatosis should be considered in patients presenting with firm nodules on the plantar aspect of the foot. When conservative therapy fails, partial plantar fasciectomy can provide excellent functional outcomes and long-term symptom relief with a low risk of recurrence.
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NewsBot · Jan 9, 2026

Real-World Treatment Patterns Among Newly Diagnosed Patients With Plantar Fibromatosis in the United States
Jill Davis etal
Source

Background
Plantar fibromatosis (PFI) is a rare condition that affects the plantar aponeurosis resulting in painful nodules on the foot/feet.
Purpose
There are no clinical guidelines for treatment in the United States, and real-world evidence regarding treatment patterns is limited.
Methods
This retrospective cohort study used linked data from adjudicated claims and electronic medical records to identify patients with incident PFI. PFI prevalence in 2021 was estimated, and treatment patterns for conservative (nonsurgical) and surgical interventions were assessed during the 24 months after diagnosis.
Results
Age- and sex-adjusted PFI prevalence was 57.03 cases per 100,000 in 2021. In the incident PFI cohort (N=620), 392 patients (63.23%) were female. During the 12-month baseline period before diagnosis, 19.03% of patients had evidence of foot/ankle pain or stiffness, and 53.55% received prescribed analgesics or steroids. Most patients (91.13%) received conservative treatment during follow-up, including injectable corticosteroids (59.19%), oral corticosteroids (44.68%), and physical/occupational therapy (PT/OT, 40.81%). On average, treated patients had 2.10 oral and 2.63 injectable steroid claims and 15.8 PT/OT visits during follow-up. Surgical interventions were rarely used (n=42; 6.77%); excision of foot tumor (n=15/42; 35.71%) was the most common surgical procedure. Following surgery, conservative treatments were commonly observed (n=39; 92.86%).
Conclusions
Our findings suggest patients newly diagnosed with PFI typically received conservative treatments. Although surgery is infrequent, conservative treatments often continue after surgery, which may suggest disease recurrence or persistent symptoms. Additional studies are warranted to develop an understanding of long-term clinical and patient-reported outcomes with/without treatment, among patients with refractory disease.
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